Maximize Your Reimbursement with Personalized Medical Billing & Coding

FAQ

• Is there a time limit for medical billing in California?

  There is no specific time limit for medical billing in California, but its 90-days for submitting claims from the date of service. Some insurance providers may have their own timelines for submitting claims, so it is best to check with the specific insurance provider for their billing timeline requirements to avoid any potential issues with reimbursement.

• Which medical billing and coding certification is best?

  The Certified Professional Coder (CPC) certification offered by the American Academy of Professional Coders (AAPC) is considered one of the best medical coding certifications. It validates the expertise in medical coding skills, knowledge, and understanding of the latest coding conventions and guidelines. It also shows a high level of ethical standards and commitment to ongoing education.

• Are medical billing codes universal?

  Yes, medical billing codes are standardized codes that follow international coding standards created by the World Health Organization (WHO). However, while the codes themselves are universal, local guidelines and regulations determine how the codes are used within specific medical specialties such as pediatrics or OBGYN. 

• What are 3 differences between medical billing and medical coding?

  1. Medical coding is the process of translating patient diagnoses and treatments into alphanumeric codes, while medical billing involves the submission of bills or claims to insurance companies or patients for reimbursement.
  2. Medical coding requires knowledge of medical terminology, anatomy, and physiology to ensure accurate coding, while medical billing requires understanding of insurance policies, pricing, and payment procedures.
  3. Medical coding is primarily focused on documenting patient information for accuracy and research purposes, while medical billing involves the financial transactions associated with healthcare services.

• What standardized code system is necessary for medical providers?

  Medical providers need to use standardized code systems, such as ICD-10, CPT, and HCPCS, to ensure accurate and consistent documentation, billing, and communication between healthcare professionals, essentially they help to avoid errors, improve patient care, and streamline healthcare operations.

• What is CPT in medical billing?

  CPT stands for Current Procedural Terminology and is a coding system used in medical billing to accurately identify and document the medical procedures performed on a patient. The CPT codes are used by healthcare professionals and insurance companies to ensure that the correct services are being billed and paid for. Deep up-to-date knowledge of local codes and guidelines is crucial for maximizing claims’ reimbursements.

• What are the 3 types of billing?

  The three types of medical billing include professional, institutional, and outpatient billing. Professional billing involves billing for services provided by individual healthcare providers like physicians or nurses. Institutional billing is for services provided by hospitals or healthcare facilities, and outpatient billing is for services provided outside of a hospital setting like clinics or ambulatory surgery centers.

• What’s the difference between PPO insurance and HMO insurance?

  PPO insurance generally allows you to choose any doctor or specialist you want to see, including out-of-network providers, but you will pay more out of pocket for those services. HMO insurance requires you to choose a primary care physician who will coordinate all of your healthcare needs and may require a referral to see a specialist, but you typically pay less out of pocket.

• What is the timely filing for claims in CA?

  In California, the timely filing limit for medical claims is typically 365 days from the date of service to be accepted and processed. Submitting appeals and dealing with complicated claims can create even more pressure. That’s is crucial for healthcare providers to stay on top of their billing and ensure that claims are filed in a timely manner to avoid potential loss of revenue.

• What is the advantage of having Outsourced Medical Billing?

  Outsourcing medical billing allows healthcare providers to focus on patient care, while leaving the billing process to specialized and experienced professionals. This leads to better accuracy, improved efficiency, and increased revenue. Additionally, outsourcing can reduce overhead costs and eliminate the need for specialized staff, and, most importantly, it frees up valuable time for healthcare providers to focus on revenue generation through quality patientcare, ultimately leading to greater success and profitability.

• What is efficient medical billing?

  Efficient medical billing is the process of accurately and promptly submitting claims for healthcare services to insurance companies for reimbursement. This involves deep knowledge of local codes and guidelines, accurate coding of diagnoses and procedures, using advanced software and tools for timely submission of claims, and effective follow-up on unpaid or denied claims. It aims to optimize the revenue cycle management of healthcare providers, ensure that patients receive timely and quality care, and doctors maximize their reimbursement.

• How fast private insurance pays claims?

  Private insurance companies in California generally follow the state’s prompt payment laws, which require them to pay clean claims within 30 days of receiving them. However, some insurers may take longer to process complex or disputed claims.